Denied Workers’ Compensation Claims Based on a Pre-Existing Condition

Posted on July 29, 2016September 19, 2016

Countless Atlanta workers suffer injuries while on the job because some aspect of their job or a workplace accident exacerbates or reinjures a pre-existing condition. Employers and workers’ compensation insurance providers, upon learning that the injury is based on a pre-existing condition, may try to deny a worker’s workers’ compensation claim, rationalizing the denial of benefits on the premise that the worker came to the workplace with the pre-existing injury, and thus the employer, or insurance company, should not be held liable for re-injuring or making the pre-existing condition worse. However, in Georgia, workers are hired as they are, with pre-existing conditions or not. Employers are not permitted to deny claims based on preexisting conditions despite whether the employer knew about the worker’s pre-existing condition or not.

Pre-existing conditions could include old injuries or illnesses, an existing problem (such as a bad back), or a condition that has since healed, but becomes re-injured or made worse by a workplace accident. For example, an existing repetitive stress injury could be made worse by an employee performing his or her daily work tasks, or a worker could twist his or her knee on the job at a location of an old football injury that made the worker’s knee weak and prone to injury. Sometimes the pre-existing injury is an old injury that has not fully healed. Whatever the case may be, if you are injured on the job in Georgia, whether you have a pre-existing condition or not, you should speak with an experienced Atlanta workers’ compensation lawyer as soon as possible to discuss your specific situation.

To be clear, the injured worker is not eligible for workers’ compensation based solely on the fact that he or she has a pre-existing condition or illness. The worker must sustain a new, subsequent injury that either re-injures or aggravates the worker’s pre-existing condition. Workers’ compensation claims based on a pre-existing condition can make things more difficult for the injured worker when it comes to obtaining workers’ compensation benefits, but these benefits cannot be denied simply because a worker had pre-existing condition.

Examples of Pre-Existing Conditions

Having a pre-existing condition can be tough – you’ve already gone through the pain of that pre-existing injury, and pain from the injury may even linger with you still. When a pre-existing injury or illness is exacerbated, aggravated, or re-injured by performing your job duties, or by a workplace accident, you may be entitled to workers’ compensation benefits. A few examples of common pre-existing conditions that become aggravated or re-injured by work include:

Back injuries;

Degenerative disc disease;

Arthritis;

Joint injuries; and

Old sports injuries.

A pre-existing condition could also cause a worker to suffer a workplace injury, and workers’ compensation claims based on these types of pre-existing conditions cannot be denied arbitrarily either. A few examples of pre-existing conditions that could cause workplace injuries include:

A worker who has the pre-existing condition of epilepsy could suffer a seizure while at work. The worker could fall to the ground and injure him or herself, or could knock something over that causes injury. Injuries resulting from a seizure are covered by workers’ compensation insurance.

A worker could have diabetes or another health condition that could trigger serious harm to the worker if the worker becomes overheated, dehydrated, or suffers through a period of low blood sugar, as a result of their job. Injuries that are the byproduct of the worker’s pre-existing condition and a work-related trigger for that condition could make a worker eligible for workers’ compensation benefits.

When Can a Workers’ Compensation Claim Be Denied Based on a Pre-existing Condition?

There are certain situations where a worker’s workers’ compensation might be denied, based on the pre-existing condition, but these denials have to do with the worker, rather than the employer. For instance, a worker who lies or is misleading about a pre-existing condition could be denied workers’ compensation benefits. Many employers ask workers at the time of hiring if the worker has any injuries or conditions that the employer should know about. Since the worker had an opportunity to disclose to their employer any pre-existing conditions, and the worker either refrained from disclosure, lied or mislead the employer, any workers’ compensation claim that might arise from the worker’s undisclosed pre-existing condition, could be denied.

Similarly, a worker who works despite their doctor’s orders and becomes injured on the job may be rendered ineligible as well. For instance, if a worker suffers a knee injury (either on their own time or work time) and the doctor instructs the worker to stay away from work, and to not put undue stress on the knee, the worker could be ineligible for workers’ compensation benefits if he or she is injured on the job. Worker’s cannot disregard their doctor’s orders.

When Do Benefits Stop?

When an injured worker is recovering from a re-injury or aggravation of a pre-existing condition, the worker will receive workers’ compensation benefits until the worker recovers to the state they were in before the re-injury or aggravation occurred. The worker will not receive benefits if they are trying to further recover from the pre-existing condition or injury. To think of this another way, the worker is only eligible for workers’ compensation benefits until he or she returns to their pre-existing condition baseline from before the reinjury, or aggravation of the pre-existing condition.

Workplace accidents and work-related injuries can leave a worker to deal with pain and recovery, and the injured worker doesn’t need to deal with the hassle of a denied or disputed workers’ compensation claim, too. Injured workers who are facing denial of their workers’ compensation claims based on the worker having a pre-existing condition need to speak with a skilled workers’ compensation lawyer in Atlanta straightaway. Bader Law Firm, LLC has assisted many Atlanta workers who have been injured on the job, with and without pre-existing conditions. Let us help you with every aspect your workers’ compensation claim. Please feel free to contact us today.